Insurance coverage for maternity care is mandatory in most individual and small group plans under the Affordable Care Act, extending this coverage where it used to be rare. However, for mums-to-be who prefer the services of midwives and birthing centres there are no guarantees.

Around 1 percent of births occur outside a hospital in the U.S. but this number is slowly increasing as more women opt for home births, birthing centres, or clinics. The number of non-hospital birthing centres increased from 170 in 2004 to 248 in January 2013. Though, at the latest count there were 13 states which still didn’t have a birthing centre at all, said the Centres for Disease Control and Prevention (CDC).

Birthing centres, typically staffed by midwives offer women with low-risk pregnancies an alternative to the traditional hospital setting, often avoiding medical interventions such as drugs to induce labour and electronic fetal monitors, and so on.

In 2012 29 percent of births outside of a hospital occurred in a birthing centre, the rest were predominantly home births. While this is still a small percentage of the total number of births nationwide, the percentage of births at these centres increased by 70 percent between 2004 and 2012, according to the CDC report.

More people are talking about midwifery birth and having their experience as they would like to have it,” Lynn Johnson, midwife and administrator of Women’s and Children’s Services at Huntington Hospital in New York, told HealthDay.

Kaiser Health News reports that the cost of delivering in a birthing centre is significantly less than in hospital. The average hospital charge for a vaginal delivery with no complications is $10,166 in 2010, this compares to $2,277 for a birthing centre.

Some advocates have predicted that coverage for birth centres and midwives will become more routine in insurance plans now Medicaid, which pays for around 50 percent of all births in the U.S. has embraced their use. However, coverage for birthing centres and midwives under private insurance plans is still uncertain.